What investigative purpose is served by a barium enema? -Richard Lund
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Well, a Baruim enema (BE) is a test that strikes terror in the hearts of those who need to have it, don't I know it. Most of us would rather pass through our lives without ever thinking about enemas of any sort, amen. The truth is, if done properly, a barium enema need not be an awful ordeal.

Basically the barium enema is a fluoroscopic test used to study the large bowel, or colon.

There are two basic types of barium enemas The regular, or single contrast, barium enema and the air contrast barium enema. The regular, or single contrast, barium enema is performed using only barium; the air contrast barium enema uses barium and together.

The indications for barium enemas remain a controversial issue. Colonoscopy-- inserting a fiber optic tube into the rectum and passing it through the large bowel-- has taken over as the definitive way of examining the large bowel. That test, though significantly more costly than the BE, is generally considered more accurate. Its real advantage is the ability to biopsy and even remove polyps (small growths that are usually noncancerous, but not always) through the same tube. Sedation is generally needed and, when effective, causes complete amnesia of the event, which is a good thing.

Though not the "gold standard," BEs are considered excellent tests for finding cancers of the colon, for looking at various inflammatory conditions such as diverticulitis, and for discovering polyps, especially with the air contrast technique. Now and then, the radiologist may be asked to actually treat a condition known as intussuseption. In this rare situation, the end of the small bowel rolls into the beginning of the large bowel. One tube slides inside the other, so they block each other. The remedy is pressure from the outside to push the inside tube back out of the outside tube (reduce the intususseption).

Colonoscopy is the principle alternative to BEs. Patients who are too debilitated, or are unable to cooperate enough to have BEs, can have alternative abdominal and pelvic CT scans that detect major large bowel pathology. There is a very new and exciting test called virtual colonoscopy that allows the radiologist to fly through the large bowel almost like a computer game.

The good news is that there are few complications to barium enemas. Most complications arise from the insertion of the enema tube and the inflation of the little balloon at the enema tip. Very rarely, patients may be allergic to the latex in the balloon. Overinflation of the balloon can result in tearing of the rectal wall, which can be a very serious complication. This complication is most apt to occur when the lining of the rectum is inflamed, such as in ulcerative colitis. It would be very unusual to overinflate a normal rectum. I am not sure if they still use versed (midazolam HCl) and demerol to sedate, but this can cause residual effect and you can be drowsy until the next day or longer depending or you bodies ability to rid itself of these toxins. I personally for myself dislike demerol. -Dee
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Sorry, I should clear up something this statement below was only meant if a colonoscopy is done.
"I am not sure if they still use versed (midazolam HCl) and demerol to sedate, but this can cause residual effect and you can be drowsy until the next day or longer depending or you bodies ability to rid itself of these toxins. I personally for myself dislike demerol. "